CITRASATE® is an acidic HD concentrate using citric acid as an acidifying agent instead of traditionally used acetic acid. Benefit for patients is especially heparin dose reduction.
After a few weeks using this concentrate I have noticed a higher frequency of hypotension and seizures at the end of dialysis or after dialysis. The increase of dialysate calcium helped only some patients. Does anyone have a similar experience?
Hi Ali,
thank you for the papers.
When switching from standard bicarbonate dialysate to Citrasate® we have increased dialysate calcium of 0,25 mmol/L as recommended. Unfortunatelly, in many patients during few weeks/months developed intradialytic hypotension and significant elevation of parathyroid hormone.
In studies I have found, such effect on PTH is not described.
Does anyone have a similar experience? Thank you.
I have downloaded papers from Ali. I've read with great interest. Here I would thank him.
Hi Marco,
we measured dialysate pH, pCO2, HCO3, ion concentrations and even intradialytic calcium and magnesium mass balances in 7 hemodialysis patients using Citrasate® (Ca 1,5, Na 142, HCO3 32 mmol/L).
The mean dialysate values: pH 7.35, pCO2 8.3, HCO3 33.2, BE 5.5, total Ca 1.55, ionized Ca 1.02, Na 141.9, Mg 0.58 mmol/L.
Total calcium mass balance: -58 mg (diffusion gradient from the dialysate to the patient, without effect of ultrafiltration), -232 mg (calculated with effect of ultrafiltration), the mean ultrafiltration was 2786ml.
Magnesium mass balance: -90 mg (without UF), -130 mg (with UF).
I read well? pCO2 is 8.3 mmHg ?
In standard bicarbonate dialysis and hemodiafiltration, the pCO2 in dialysate is around 100 mmHg and patient needs to breath away CO2 loading from dialysate. This leads to hyperventilation and therefore to normo or hyper O2
when you switch the patient to Citrasate there is a relevant change : the pCO2 in dialysate is very low (as was the case of the acetate-dialysis), hence patients lose pCO2 in dialysate. This leads to hypoventilation and therefore to hypoxia and possibly to hypotension and seizures.
If pCO2 is 8.3 kPa my assumption vanishes.
Let me know !!
Dialysate pCO2 is 8.3 kPa.
predialysis serum concentration: pH 7.34, pCO2 5.08 kPa, HCO3 20.3, Ca 2.21, Ca++ 1.17 mmol/L
postdialysis serum concentration: pH 7.44, pCO2 5.35 kPa, HCO3 26.4, Ca 2.39, Ca++ 1.14 mmol/L
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